D3.35 - Severe atopic dermatitis poorly controlled, or something else?

Atopic dermatitis (AD) is a chronic, multifactorial inflammatory disease. Allergic contact dermatitis (ACD) is an allergic condition that can coexist with AD and contribute to exacerbations. 

Propolis or beeswax is a product made by bees from the resin of certain plant species. 

We present a case of 29-year-old man with a history of severe atopic dermatitis since childhood.

Chronic eczema of hands from 1 year of evolution with poor control with topical treatment with methylprednisolone aceponate and tachromilium.

He had erythematodermic lesions, excoriated, liquenified on both hands.

The study was conducted with epicutaneous tests using the extended standard battery of the Spanish Group for Research on Contact Dermatitis and Skin Allergy (GEIDAC) with 55 standardized components, with 3 readings, at 48 and 96 hours and 7 days.

Results: propolis (10% in vaseline) (++), with relevance present after being found in the list of ingredients of topical tacrólimus as white wax.

Improvement in lesions after changing tacrólimus for pimecrolimus

The forms of clinical presentation of AD are very variable, but usually includes eczema. 

ACD is a delayed hypersensitivity reaction to contact allergens. Its clinical presentation is in the form of eczema, so differentiation between DA and DCA is difficult. 

Epicutaneous tests are the gold standard for the diagnosis of DCA.

Tacrólimus topical has propolis in its ingredients, such as white beeswax. The treatment of choice for maintaining eczema in moderate and/or severe stages.

The patient we presented had tacrólimus applied to the eczema of the hands for at least one year, with no resolution.

Severe AD and chronic, poorly developed hand eczema should be patched when they are resistant to topical treatment, as they may associate with a DCA that prevents the control of lesions. Note that topical treatments may contain relevant allergens that will cause new disease or aggravate existing disease.